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Dosing guidelines for epoetin and darbepoetin in adults

Dosing guidelines for epoetin and darbepoetin in adults
  3 times weekly dosing Weekly dosing
Epoetin alfa
Starting dose (adults): 150 units/kg SC 3 times weekly 40,000 units SC*
Reduce dose by 25% if: Hemoglobin reaches a level needed to avoid transfusion or increases >1 g/dL in any 2-week period.
Withhold dose if: Hemoglobin exceeds a level needed to avoid RBC transfusion; restart at 25% below the previous dose when the hemoglobin approaches a level where transfusions may be required.
Increase dose: To 300 units/kg SC 3 times weekly if response is not satisfactory (rise in hemoglobin <1 g/dL after 4 weeks of therapy and it remains below 10 g/dL) to achieve and maintain the lowest hemoglobin level sufficient to avoid the need for RBC transfusion. To 60,000 units SC weekly if response is not satisfactory (rise in hemoglobin <1 g/dL after 4 weeks of therapy and it remains below 10 g/dL) to achieve and maintain the lowest hemoglobin level sufficient to avoid the need for RBC transfusion.
Discontinue if: After completion of the chemotherapy course, or if after 8 weeks of therapy, there is no response as measured by hemoglobin levels or transfusions are still required.
  Weekly dosing Once every 3 weeks dosing
Darbepoetin alfa
Starting dose (adults): 2.25 microgram/kg SC once weekly 500 micrograms SC every 3 weeks
Reduce dose by 40% if: Hemoglobin exceeds a level needed to avoid transfusion or increases >1 g/dL in any 2-week period.
Withhold dose if: The hemoglobin exceeds a level needed to avoid RBC transfusion; restart at 40% below the previous dose when the hemoglobin approaches a level where transfusions may be required.
Increase dose: To 4.5 microgram/kg if response is not satisfactory (no reduction in transfusion requirements or rise in hemoglobin <1 g/dL after 6 weeks of therapy in the absence of RBC transfusion) to achieve and maintain the lowest hemoglobin level sufficient to avoid the need for RBC transfusion. N/A
Discontinue if: After completion of the chemotherapy course, or if after 8 weeks of therapy, there is no response as measured by hemoglobin levels or transfusions are still required.

N/A: not applicable; RBC: red blood cell; SC: subcutaneously.

* If initial therapy is tolerated and effective, extended dosing schedules may be used (eg, 80,000 units every 2 weeks or 120,000 units every 3 weeks).
Data from: US Food and Drug Administration.
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